Provider Demographics
NPI:1912966045
Name:HEBERT, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE 615
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:972-388-5970
Mailing Address - Fax:972-388-5970
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 615
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:972-388-5970
Practice Address - Fax:972-388-5971
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4433207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156311610Medicaid
TX8CE649OtherBCBSTX
TX7966631OtherAETNA
TX156311611Medicaid
TX207734OtherPACIFICARE
TX156311612Medicaid
495733OtherWELLCARE
495733OtherWELLCARE
TX8F23383Medicare PIN
TX8CE649OtherBCBSTX